Provider Demographics
NPI:1093003352
Name:STUCKEY, LUQRETIA SHONETT (LCSW, CADC)
Entity Type:Individual
Prefix:MS
First Name:LUQRETIA
Middle Name:SHONETT
Last Name:STUCKEY
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 CHRISTINA ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61104-7039
Mailing Address - Country:US
Mailing Address - Phone:815-742-1076
Mailing Address - Fax:
Practice Address - Street 1:1321 N 7TH ST
Practice Address - Street 2:
Practice Address - City:ROCHELLE
Practice Address - State:IL
Practice Address - Zip Code:61068-1185
Practice Address - Country:US
Practice Address - Phone:815-562-3801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
IL1490179801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)